One in every 150 patients admitted to a hospital will die as a result of an ‘adverse event’: an unintended injury or complication
caused by health care management, rather than by the patient’s underlying disease. More than half of these adverse events
can be attributed to a surgical discipline. The past decades have seen a change in the way the medical community thinks about
medical error. The blaming culture previously encountered in most hospitals has gradually developed into a more open culture
focused on systems. This culture change towards more transparency and ‘system thinking’ has cleared the way for interventions
to improve patient safety. The present thesis describes the various studies that were conducted regarding the SURgical PAtient
Safety System (SURPASS) checklist, a comprehensive safety checklist covering the surgical patient pathway from admission to
discharge. The SURPASS checklist was developed, validated and subsequently evaluated in various ways; among others, by comparing
complication and mortality rates before and after implementation of the checklist, analysing incidents intercepted by the
use of the checklist and studying surgical malpractice claims.

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